Radiographic features predictive of patellar maltracking during total knee arthroplasty
Radiographic features predictive of patellar maltracking during total knee arthroplasty
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DOI：
10.1007/s00167-009-0832-y
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发表时间：
2009-10-01
影响因子：
3.8
通讯作者：
Amis, Andrew A.
中科院分区：
文献类型：
--
作者：
Chia, Shi-Lu;Merican, Azhar M.;Amis, Andrew A.
尽管部件设计和手术技术有所改进，但一些患者在TKA期间仍然需要外侧支持带松解以改善髌骨轨迹。我们研究了148例固定平台TKA，以确定术前膝关节X线片中可预测术中髌骨轨迹不良的参数。使用数字X线片和软件测量冠状面对线、股骨远端外翻角、胫骨近端内翻角、髌骨倾斜、髌骨移位、Insall-Salvati比率和髌骨部件放置和对线。在所有部件都用骨水泥固定后，使用无接触和改良的“毛巾夹”技术评估髌骨轨迹。唯一与轨迹不良独立相关的影像学参数是髌骨移位。有轨迹不良的患者术前髌骨外侧移位的中位数为4.1 mm，而无轨迹不良的患者为0.0 mm。髌骨移位超过3.0 mm的患者有很高的轨迹不良可能性，估计阳性和阴性预测值分别为78%和95%。因此，术前髌骨移位可能与识别TKA期间髌骨轨迹不良可能性较高的骨关节炎患者具有临床相关性。患者研究人群中髌骨轨迹不良内在风险的变化可能是髌骨轨迹不良报告率差异很大的原因，我们的数据表明，术前髌骨移位的信息可能有助于对这些样本人群进行分层。
Despite improvements in component design and surgical technique, some patients still require lateral retinacular release during TKA to improve patella tracking. We studied 148 fixed-bearing TKAs to identify parameters in pre-operative knee radiographs that would predict intraoperative patellar maltracking. Digital radiographs and software were used to measure coronal alignment, distal femoral valgus angle, proximal tibia varus angle, patellar tilt, patellar shift, Insall-Salvati ratio, and patellar component placement and alignment. Patellar tracking was assessed after all components had been cemented, using both no-touch and modified "towel clip" techniques. The only radiographic parameter independently associated with maltracking was patellar shift. The median pre-operative patellar lateral shift in patients who had maltracking was 4.1 mm compared to 0.0 mm in those who did not. Patients who had a patellar shift of more than 3.0 mm had a high likelihood of maltracking, with estimated positive and negative predictive values of 78 and 95%, respectively. Pre-operative patellar shift may thus be clinically relevant for identifying osteoarthritic patients who have a higher likelihood for patellar maltracking during TKA. Variations in the intrinsic risk for maltracking within patient study populations may account for the widely differing reported rates of patellar maltracking, and our data suggest that information on pre-operative patellar shift may be helpful in stratifying these sample populations.